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Washington Post Detainee Health Care Series – Day 2

The Washington Post began a four part series on Sunday, May 11th on detention health care.  The second article in the series focuses on the health care provided to Yong Harvill.

If you are reading this series, you may also be interested in the following:

Myths vs. Facts regarding the May 12, 2008, article:

Myth:  “Yong Harvill…… She noticed the lump under the thin, blue cotton in August, five months after federal immigration officers, to her amazement, took her into custody to try to deport her for buying stolen jewelry more than a decade ago.”

Fact:  ICE is specifically prohibited by the Privacy Act from commenting on the medical records or treatment of an individual detainee.  However, under the Immigration and Nationality Act, once an individual is convicted of any one of a number of crimes, that individual may be subject to removal. To ensure that individuals who have been convicted of a crime and who are amenable to removal are not released back into society at the conclusion of their sentence, ICE created the Criminal Alien Program.  This program identifies individuals in federal, state and local jails and places them into removal proceedings at the conclusion of their incarceration.

Myth:  “The lump grows slowly. It is now three inches across. And though she keeps asking, no one has done a test to see whether her sarcoma has come back.”

Fact:  ICE is specifically prohibited by the Privacy Act from commenting on the medical records or treatment of an individual detainee; however, ICE detainee health care is equal to or better than that provided to U.S. citizens in custody.  Each detainee is medically screened upon arrival and last year, 34 percent were diagnosed and treated for pre-existing chronic conditions.  ICE routinely provides medical care for life threatening conditions, such as cardiac arrest, kidney disease, high risk pregnancies, HIV/AIDS, hypertension, and diabetes.  ICE detainees also receive dental visits, physical exams, sick call visits, prescriptions and mental health visits.

Myth: “They are locked up in a patchwork of out-of-the-way federal detention compounds, private prisons and local jails. This unnoticed prison system was built for a quick revolving door of detainees -- into custody, out of the country. But often, people linger in detention for months or years.”

Fact:  It is important to note that the length of stay in an ICE detention facility is considerably shorter than that of a correctional facility.  In 2007, ICE detainees spent an average of 37.5 days in detention. Decisions regarding detention are made on a case-by-case basis, taking into account a number of factors, including whether or not mandatory detention is required, whether the individual poses a threat to national security or public safety and whether he or she is a flight risk.
All individuals involved in the removal process have the right to full due process of law, such as a hearing before an Immigration Judge and the right to appeal before the Board of Immigration Appeals and the U.S. Circuit Court of Appeals. As such, some removal cases are lengthier than others, which can result in an individual being detained for longer periods of time.

Myth: “Two months after ICE agents seized Harvill in Florida, they transferred her to Arizona last May, saying a federal compound called the Florence Service Processing Center was better suited to handle her medical care. Four weeks later, they moved her, without explanation, a few miles down a cactus-lined highway to a county jail that hasn't had a full-time staff doctor since she arrived.”

Fact:  As a measure to ensure overcrowding does not exist at ICE facilities, ICE routinely moves detainees to other locations.  In fact, oftentimes, when a facility reaches its capacity, we immediately take action to bring the population down to eliminate the strain of overcrowding.  Further, a detainee may be moved to a facility that can better handle specific medical issues.

Myth: “The day after she arrived, Harvill saw a nurse and a doctor for a checkup that all new detainees are supposed to have, but don't always get.”

Fact:  Nearly 1.5 million individuals have come through detention facilities since ICE was created in 2003 through fiscal year 2007.  Another 345,000 are expected to pass through ICE detention in fiscal year 2008.  Each of them received taxpayer-funded comprehensive medical screening and, for those remaining in ICE custody at least 14 days, a comprehensive physical examination.  Each also received specific treatment, as medically necessary.  Care management was provided by the Division of Immigration Health Services or local Intergovernmental Service Agreement (IGSA) contractors at a cost of more than $360 million.

Myth: “Harvill gets shuttled back and forth to the hospital in Phoenix because the jail does not have a doctor on its staff.”  “According to internal government documents, one-third of the 29 medical positions at the Pinal County Jail were vacant as of February. The jail, the Florence compound and the large compound in nearby Eloy each had no full-time doctor.”

Fact:  According to ICE records, the Pinal County Detention Facility, ICE Medical Clinic is staffed with a Health Services Administrator (HSA), two Mid-Level Providers (MLPs) such as a Nurse Practitioner and Physician’s Assistant, a Pharmacist, one Pharmacy Technician, six Registered Nurses (RNs), four Licensed Practical Nurses (LPNs), one Administrative Assistant and four Medical Records Technicians (MTRs). While not on site full time, there is also a Physician, a Psychiatrist and a Psychologist that provide services to the detainees at Pinal County on a regular basis. In addition, the Medical Clinic has full laboratory capabilities as well as a fully staffed pharmacy on site.  Further, the facility does rely on specialists in the local area.

Myth: “Whether the gaps in Harvill's treatment are by accident or by design is difficult to discern. Yet it is clear that the obscure federal agency that oversees detainees' medical care, the Division of Immigration Health Services (DIHS), operates with a top priority of limiting care and saving money. Its medical mission is only to keep people healthy enough to be deported.”

Fact:  The mission of DIHS is to provide appropriate medical care for ICE detainees.  The DIHS Detainee medical care primarily provides health care services for emergency care.  Accidental or traumatic injuries incurred while in the custody of ICE and acute illnesses will be reviewed for appropriate care.  Other medical conditions which the physician believes, if left untreated during the period of ICE custody, would cause deterioration of the detainee’s health or uncontrolled suffering affecting his/her deportation status will be assessed and evaluated for care.  Each claim is reviewed by a medical professional on an individual basis for appropriateness and medical necessity. 

Myth: “Instead of listing, as most health plans do, the services available to patients, the manual specifies services that are "usually not covered" for allergies, heart problems and other illnesses. Cancer is not mentioned at all.” 

Fact:  The DIHS benefit package, to include services available for detainees, is available on the DIHS website www.icehealth.org for public review. 

Myth: “Internal government documents obtained by The Post show that most requests are approved.  But the documents also show that, when requests come in for people with serious problems, there can be pressure to cut costs.”  “One chart, covering October 2005 to September 2006 -- seven months before Harvill became an immigration detainee -- is labeled "TAR Cost Savings Based on Denials." The agency, the chart shows, saved $129,713 by denying 17 medical requests for people with HIV, $36,216 by denying seven requests for people with various forms of psychosis, $91,926 by denying 27 requests for people with chest pain and $9,545 by denying treatment for a case of blood in stool, one of the problems Harvill has had for months.”

Fact:  In fact, Treatment Authorization Requests (TAR), which are requests for off site medical care, are approved at a very high rate.  However, a TAR may be denied because of available alternative procedures or the treatment is available on site.  Thus, a TAR is not determined with an effort to cut costs.

Myth: “These sorts of machinations prompted the deputy warden at York County Prison in Pennsylvania, which houses many immigrant detainees, to fire off an angry letter about the health services division. "[I]n my opinion, they have set up an elaborate system that is primarily interested in delaying and/or denying medical care to detainees," the warden, Roger Thomas, wrote in late 2005. "There is nothing easy about working with DIHS. If something can be delayed, it is delayed. If it can be denied, it is denied. If it can be difficult, it is made difficult. Most importantly, if there is some bureaucratic procedure that will delay/deny treatment to a detainee . . . you can be assured that DIHS will do it."  Harvill's lawyers have tried to find out how many requests for treatment have been sent from Pinal County Jail on her behalf and how Washington has ruled on each one. They filed a Freedom of Information Act request last summer and, after two months, got an incomplete answer. In January, they left a phone message for the division's medical director. No one has called back.”

Fact:  Without speaking specifically to Ms. Harvill’s case, each detainee is given the highest level of care.  DIHS treats each TAR case on an individual basis and at times may request more information to make an informed medical decision.

Myth: “The thing that makes perhaps the least sense to him is that his wife is covered under a good health insurance policy that he gets through his union, the International Brotherhood of Boilermakers, and she and her lawyers have asked whether she could use that policy to pay for her treatment by private doctors while she is detained. They have been told no.”

Fact:  A decision on appropriate medical care is made between the patient and the physician.  If necessary ICE will transport a detainee to an approved specialists to obtain appropriate and necessary medical care.  DIHS uses a similar standard in determining the appropriate procedures for an individual as any other healthcare provider—appropriateness and medical necessity.

 

 

# ICE #
U.S. Immigration and Customs Enforcement (ICE) was established in March 2003 as the largest investigative arm of the Department of Homeland Security. ICE is comprised of five integrated divisions that form a 21st century law enforcement agency with broad responsibilities for a number of key homeland security priorities.